How Y-90 targets liver cancer with precision

Radiation therapy has long been an effective and safe cancer treatment, but Y-90 radioembolization delivers it in a unique way.

In the case of liver cancer, doctors inject tiny beads containing Yttrium-90, a radioactive substance, through the blood vessels that feed a liver tumor. Once there, the beads release radiation, targeting and destroying cancer cells while leaving much of the surrounding healthy liver untouched.

Unlike traditional surgery, Y-90 is minimally invasive and performed by an interventional radiologist. Before treatment, mapping is performed to study the liver's blood supply and determine the safest route to deliver radiation to a tumor.

At Sharp Grossmont Hospital, interventional radiologist Dr. Michael Khanjyan performs the procedure.

"In addition to helping select appropriate candidates, my role is to create a roadmap to the tumor, determine the right dose, and safely deliver the treatment precisely where it's needed," says Dr. Khanjyan. "But Y-90 is very much a team effort, with specialists across multiple disciplines working together to care for the patient."

Although Y-90 is not a cure for all liver cancers, for those with a single tumor, it may be effective. For others with multiple tumors, it can still make a meaningful difference, helping extend survival from months to years while easing symptoms and improving quality of life.

How Y-90 radioembolization targets liver cancer

According to Dr. Khanjyan, liver tumors get almost all their blood supply from one specific set of blood vessels, while the healthy liver around them receives blood from a different network. "We take advantage of that difference and thread a thin catheter into the artery feeding the tumor and release the tiny beads — each about the width of a few human hairs," he says.

Using real-time imaging, he guides the catheter through a small opening in the groin artery and up to the liver. The beads are released directly into that blood supply, where they lodge in the tumor and deliver radiation for about two weeks.

Because liver tumors draw most of their blood from a different set of vessels than healthy liver tissue, the treatment is highly targeted.

Benefits of Y-90

• Outpatient procedure and faster recovery
  
  Many patients are surprised to learn that the Y-90 procedure is an outpatient procedure.
  
  "Patients sometimes expect cancer treatment involving radioactive material to mean a hospital admission and are relieved to hear otherwise," says Dr. Khanjyan. "Most patients go home the same day."
  
  Because the procedure requires only a small needle puncture rather than a surgical incision, recovery is quicker than traditional liver surgery. Most patients return to normal daily activities within one to two weeks, sometimes sooner.
  

• Minimal side effects The most common side effects are fatigue and, occasionally, mild abdominal discomfort or low-grade nausea for a few days.
  
  "That's a meaningful difference compared to recovering from open liver surgery," says Dr. Khanjyan.
  

• Less invasive than surgery Traditional liver surgery involves removing the tumor along with a margin of surrounding liver tissue. It requires general anesthesia, an abdominal incision, a hospital stay and a recovery period that can last weeks to months. In contrast, Y-90 is delivered through a small catheter, making it a minimally invasive option for eligible patients.
  
  “Y-90 is part of an individualized approach that may be performed instead of surgery or as a bridge to surgery in others,” he adds.

Who might benefit from Y-90?

According to Dr. Khanjyan, patients may be a good fit for Y-90 if they:

• Have primary liver cancer or cancer that has spread to the liver, such as colorectal or neuroendocrine cancer.

• Have cancer confined mainly to the liver, or where the liver is the dominant problem, even if there’s disease elsewhere.

• Have adequate liver function, allowing healthy liver tissue to tolerate the treatment.

• Are not good candidates for surgery because of a tumor's size or location, underlying liver disease or the presence of multiple tumors.

• May benefit from shrinking a tumor before surgery or a liver transplant.

The future of liver cancer treatment

Y-90 is just one example of how treatment for liver cancer has evolved over the years.

"A liver cancer diagnosis today is not treated the way it was 10 or 15 years ago," says Dr. Khanjyan. "Now, it’s tailored to each patient's needs, using a multidisciplinary approach rather than one-size-fits-all."

Patients who may have been told there were few treatment options because their cancer was inoperable, their liver couldn't tolerate surgery, or systemic therapy alone wasn't working now have access to targeted therapies such as Y-90, offering new possibilities and hope.

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